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January 2005

Overview

The HIV Rapid Testing in Non-Clinical Settings Demonstration Project meets strategy 2 of the Advancing HIV Prevention Initiative: implementing new models for diagnosing HIV infections outside medical settings. Through consultation with community-planning groups (CPGs), health departments, and other local organizations representing populations at high risk for HIV, community-based organizations (CBOs) will identify and provide rapid HIV testing to local populations with 1) a high prevalence of HIV; 2) an overall high risk for HIV infection; and 3) a lesser likelihood of accessing traditional HIV counseling, testing, and referral services. These consultations will also help to identify areas, frequented by persons at higher risk for HIV or by members of populations with high HIV prevalence, to serve as testing venues. Through active follow-up and provision of additional services that may reduce barriers to accessing care (e.g., provision of transportation services, HIV case manager), CBOs will ensure that HIV-infected persons are successfully linked with HIV medical care and psychosocial services.

Goals

Seven CBOs are funded under this demonstration project to conduct HIV rapid testing in non-clinical, outreach settings. CBOs will be able to focus on persons who may be less likely to access services in traditional medical settings and who also are at higher risk for HIV infection.

Goals of this demonstration project are

• to increase knowledge of HIV serostatus among high-risk racial and ethnic minorities,
• identify potential non-clinical venues for recruiting persons within the target testing populations, and
• increase and ensure access to treatment and care services among HIV-infected persons belonging to high-risk minority groups.

Collaborator Projects

Los Angeles, California, Bienestar Human Services, Inc., an agency that serves the Latino community of Los Angeles, is collaborating with AIDS Healthcare Foundation (AHF) to offer rapid HIV testing in designated sites throughout Los Angeles County. Target groups include men who have sex with men (MSM), men who have sex with men and women, injection drug users, women at sexual risk, and transgenders. Bienestar and AHF will use separate mobile testing units to access Los Angeles County service planning areas (SPAs) with the highest seropositivity rates. Other sites to be targeted include gay and/or transgender nightclubs and bathhouses.

San Francisco, California, Continuum, for its Tenderloin Neighborhood Testing project, will target African-American and Latino residents of the Tenderloin area of San Francisco, focusing particular attention on injection drug users, male-to-female transgender persons, and the homeless. Continuum will conduct testing in a tent, to be set up at sites such as public parks, transgender clubs, check disbursement sites for persons receiving general assistance or Social Security disability funds, needle exchange sites, and single room occupancy hotels.

Detroit, Michigan, Community Health Awareness Group (CHAG) will focus on low income and/or homeless African-American injection drug users, men who have sex with men who also inject drugs (MSM/IDU), and high-risk heterosexuals (commercial sex workers and/or the sex partners of IDUs, MSM/IDUs, or persons who are HIV positive) in the Detroit metropolitan area. CHAG will use a mobile van to offer testing at needle exchange programs; the 36th District Court (where CHAG provides HIV education for sex solicitation arrestees); and shelters serving women, the homeless, and substance-abusing and/or mentally ill persons. CHAG will also offer testing at fixed sites, such as methadone treatment and needle exchange programs.

Washington, District of Columbia, Whitman Walker Clinic (WWC), a CBO offering clinical services, will focus on African Americans and Latinos in the District of Columbia, suburban Maryland, and northern Virginia. Subpopulations that will be specifically targeted during outreach sessions include MSM, IDUs, heterosexual men and women, sex workers, and transgenders. WWC will use two testing teams—an African-American team and a Latino team—to conduct rapid HIV testing via a mobile testing unit at venues where the clinic’s specific targeted populations congregate. Proposed outreach test sites include parks, drug and/or cruising areas, sex trade areas, low income housing complexes, shelters, corner stores, and sex clubs. WWC also plans to offer testing at community events and health fairs that serve the African-American and Latino communities.

Kansas City, Missouri, Kansas City Free Clinic (KCFC), a CBO offering clinical services, will collaborate with three CBOs (Move UP, Inc., Imani House, and ReDiscover), the Kansas City Health Department, the Missouri Department of Health, the clinic’s Community Advisory Board, and other identified interested community providers to effectively reach at-risk communities of color. Rapid HIV testing will be offered at the three CBOs and through a mobile testing unit. All rapid testing services will be provided in street, neighborhood, and community agency locations where high-risk minorities congregate. Proposed outreach sites to be accessed by the mobile testing unit include parks, areas of high-volume prostitution, homeless shelters, motels, and adult movie theaters.

Boston, Massachusetts, Health Services Partnership of Dorchester (HSP—made up of Dorchester House Multi-Service Center and Codman Square Health Center), a CBO offering clinical services, will target persons of color living in Dorchester, Mattapan, and Roxbury for rapid HIV testing. HSP will focus on injection drug users, sex partners of HIV-infected persons (typically women of color), adolescents, and sexually active members of resident immigrant and refugee communities from countries with a high prevalence of HIV/AIDS. HSP will conduct testing at both fixed and mobile outreach sites. Fixed sites include agencies that serve Haitian and Vietnamese populations, and shelters serving women and the homeless. Testing will be offered via a mobile testing unit at outreach sites, including parking lots, parks, and areas frequented by sex workers, MSM, and IDUs. In addition, HSP will collaborate with other community agencies to recruit high-risk minorities for testing at Dorchester House Multi-Service Center or Codman Square Health Center. Both centers will offer rapid HIV testing to walk-in clients and to those referred by other agencies.

Chicago, Illinois, The Night Ministry (TNM) is a non-profit, non-denominational service organization serving homeless adults and youth, working poor adults, and uninsured and underinsured persons seeking medical assistance. For the rapid HIV testing project, TNM will focus on homeless youth and adults; the uninsured; persons with alcohol or substance abuse issues; women and men who exchange sex for money, drugs, or survival; and other at-risk populations. TNM will offer testing via a mobile testing unit at public parks, street corners, and other areas where these persons congregate, as well as at health fairs and local colleges. Fixed testing sites include youth and homeless shelters, a transitional living program for young single mothers, and a teen health center.

Project Milestones

• Funding announcement: April 2003
• Selection of contractors: June 2003
• Investigator meetings: November 2003; possible second meeting in fall 2004
• Rapid test implementation: April 2004–May 2004
• Site visits: November 2003–February 2004 for implementation site visits; other site visits will be planned as needed.

Data Collection

The project will use CDC-supplied data forms to collect quantitative data (i.e., demographics, risk, testing history, information on the rapid test, confirmatory testing, and referrals to medical care and other services) on all persons tested through the project. Currently, these are hard-copy forms. An Access database is under development and will soon be provided to the sites along with laptops for data entry in the field. Qualitative data will be collected from CBOs through focus groups and/or follow-up interviews with clients who have been served.

Results to Date

CBOs initiated data collection in May and June 2004. Continuum in San Francisco, CA, was the first site to implement rapid HIV testing for the project. Continuum identified four persons with reactive rapid HIV test results during the first week of testing. Similarly, The Night Ministry found its first HIV-positive person after conducting fewer than 30 tests.

The number of rapid HIV tests performed by each CBO and the number of confirmed positive HIV tests are included in the following table.

*Only those HIV-positive tests assumed to be new positives (not previously diagnosed) are included in this table.

In addition to quantitative data, CBOs have provided valuable information regarding operational issues and ideal methods for developing and implementing similar programs. This type of information is particularly useful because one of the goals of these demonstration projects is to develop best practices guidelines for use by other organizations.